3 Tips to Cinch Your Colonoscopy Coding
Published on Tue Apr 27, 2004
Don't let inappropriate bundles cost you $500 or more You have to consider many factors when reporting colonoscopies -- the various types of scopes, surgical techniques, instruments and locations, and, of course, how to avoid bundling -- but by remembering three helpful hints you can easily navigate this coding maze. 1. Answer 3 Questions: What? Where? How? First, you must read the physician's dictation and verify that he performed a colonoscopy, says Sherri Brasher, insurance and billing specialist at a physician practice in Indiana.
If the physician performs polypectomy: Find out how she removed the polyp (biopsy or snare). In the case of multiple polyp removal, determine where on the colon each polyp was located and whether they were in separate locations or close enough to be considered one location. Next, you should check the method by which the surgeon removed each polyp, Brasher says.
To help you through ambiguous chart documentation, remember these code/procedure descriptions:
CPT 45380 -- Cold Biopsy Forceps. These are disposable forceps that take tissue samples during an endoscopy. No electric current passes through them - thus, the term "cold." You cannot use these forceps to cauterize bleeding that the forceps may cause. A partial polypectomy is usually a cold biopsy, Brasher says, whereas a total or entire procedure is done with a snare (45385), which lassoes the polyp.
45381 -- With Directed Submucosal Injections. This relatively new code, 45381 (Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal injection[s], any substance), became effective on Jan. 1, 2003. The "substance" could include saline, India ink, methylene blue, Botox or steroids. Because the code is still new, be sure to verify coverage with your carrier, says Margaret Lamb, RHIT, CPC, of Great Falls Clinic in Great Falls, Mont.
45382 -- Control of Bleeding. No, it's not a trick: Surgeons may use many of the same techniques for cauterization (to control bleeding) and for ablation - and the code definition can also be confusing. But the defining factor is the diagnosis. For example, use 45382 when controlling bleeding from a polyp removed several days ago or for diverticulosis 562.12 (Diverticulosis of colon with hemorrhage) or 562.13 (Diverticulitis of colon with hemorrhage). Another application, Brasher says, is for angiodysplasia 569.85 (Angiodysplasia of intestine with hemorrhage).
Note: You cannot separately bill 45382 if the surgeon has caused the bleeding during the colonoscopy.
45383 -- Ablation. An ablation, normally performed during a follow-up colonoscopy, usually refers to a cauterization performed with an argon plasma coagulator (APC), heater probe, or other device that destroys any remaining polyp cells after a prior colonoscopy in which the surgeon removed a larger polyp using a snare.
When using any of these methods either for an ablation or to control bleeding, use 45383 [...]
